We have all seen innumerable television dramas in which a patient falls into a coma and the bereaved family members attempt everything imaginable to resuscitate them, from standing by their side and telling them stories to playing their favorite music, all in the goal of breaking through. Unfortunately, comas are a medically intricate phenomena with a variety of possible causes and effects, and despite modern medicine's breakthroughs, we remain mostly ignorant of how to properly cure one. A coma is a deep state of prolonged unconsciousness in which a person cannot be awakened, fails to respond normally to painful stimuli, light, or sound, lacks a normal wake-sleep cycle and does not initiate voluntary actions. It can endure from a few minutes to many years and can result in death in the most severe cases. A patient in a coma seems to be asleep and is unresponsive to any stimuli, even pain.
WHAT CAUSES A COMA?
Comas are caused by brain injury.
Brain injury can occur as a result of increased pressure, hemorrhage, oxygen deprivation, or toxic accumulation. Temporary and reversible injuries are possible. Additionally, it might be permanent.
Over 50% of comas are caused by head trauma or problems with the brain's vascular system. Comas can be caused by a variety of factors, including the following:
Brain damage can be caused by an anoxic injury. This is a neurological disorder caused by a complete absence of oxygen to the brain. For a few minutes, a lack of oxygen kills brain cells. Anoxic brain damage can occur as a result of a heart attack (cardiac arrest), a concussion, drowning, a drug overdose, or poisoning.
Trauma: Head injuries can cause the brain to enlarge and/or bleed. When the brain expands due to trauma, the fluid presses on the skull. The swelling may eventually force the brain to push down on the brain stem, resulting in damage to the RAS (Reticular Activating System), a region of the brain responsible for alertness and awareness.
Swelling: Swelling of brain tissue can occur in the absence of pain. Swelling can occur as a result of a lack of oxygen, an electrolyte imbalance, or hormones.
Bleeding in the brain layers may result in coma as a result of edema and compression on the affected side of the brain. Compression of the brain causes it to move, resulting in injury to the brainstem and the RAS (mentioned above). Hypertension, cerebral aneurysms, and tumors are all non-traumatic causes of brain hemorrhage.
Stroke: When there is insufficient blood supply to a significant portion of the brain stem or when there is blood loss followed by edema, coma can occur.
Blood sugar: When blood sugar levels remain extremely high in patients with diabetes, coma can ensue. This is referred to as hyperglycemia. Hypoglycemia, or dangerously low blood sugar levels, can potentially result in a coma. Typically, this sort of coma is reversible after the blood sugar level is stabilized. Prolonged hypoglycemia, on the other hand, might result in chronic brain damage and persistent unconsciousness.
Oxygen deficiency: Oxygen is required for proper brain function. Cardiac arrest results in an abrupt cessation of blood flow and oxygen to the brain, referred to as hypoxia or anoxia. Additionally, oxygen deprivation can develop as a result of drowning or choking.
Coma can also be caused by infections of the central nervous system, such as meningitis or encephalitis.
Seizures: A single seizure is extremely unlikely to result in coma. However, ongoing seizures, referred to as status epilepticus, are possible. Repeated seizures can impair the brain's ability to recover between seizures. This results in a protracted state of unconsciousness and coma.
Toxins: Substances occurring naturally in the body can build to dangerous amounts if the body does not properly dispose of them. Ammonia, for example, can collect to dangerous amounts in the body as a result of liver disease, carbon dioxide from a severe asthma attack, or urea from kidney failure. In significant doses, drugs and alcohol can also impair cell function in the brain.
WHAT ARE THE DIFFERENT COMA TYPES?
Comas can be classified into the following categories:
- Persistent Vegetative State: This is a profound condition of unconsciousness. The individual is ignorant of their environment and unable to move on their own. With a chronic vegetative state, an individual may regain consciousness but have no higher cognitive function. There is breathing, circulation, and sleep-wake cycles in a chronic vegetative state.
- Encephalopathy due to toxic-metabolic agents. This is a severe case of brain malfunction characterized by confusion and/or delirium. Generally, the condition is reversible. There are several causes of toxic-metabolic encephalopathy. They include illnesses such as systemic sickness, infection, organ failure, and others.
- Medically induced coma or profound state of unconsciousness: This sort of transient coma is used to prevent the brain from swelling following an injury. A regulated amount of anesthetic is administered to the patient, causing a loss of sensation or consciousness. The individual's vital signs are then continuously monitored by doctors. This occurs exclusively in intensive care units of hospitals.
MONITORING AND TREATING COMA
The Glasgow Coma Scale is the tool used by doctors to assess an individual’s level of consciousness. This level is consistently monitored for signs of improvement or deterioration. The Glasgow Coma scale assesses a person’s eye opening state, verbal response to a command and voluntary motions in response to a command.
Treatment for a coma is determined on the etiology. Families and friends of the unconscious patient should provide as much information as possible to assist doctors in determining the reason of the coma. Treatment of possibly reversible disorders requires prompt medical intervention. Antibiotics, for example, may be required if there is a brain infection. In the event of a diabetic shock, glucose may be necessary. Additionally, surgery may be required to alleviate pressure on the brain caused by edema or to remove a tumor. Long term treatment may involve providing nutrition, putting in measures to prevent infections and then regular movement of the person to prevent bedsores and tight joints.
In some cases, regular visitation and care by relatives, friends or loved ones helps salvage the situation, as research has shown that stimulation of the main senses could potentially help a person recover from a coma.
Certain medications may also help reduce edema. If required, medication may also be administered to prevent seizures.
Coma therapy is often supportive. Individuals in comas are monitored in an intensive care unit and may require continuous life support until their condition improves.
PROGNOSIS OF A COMA
The prognosis for a coma varies according to the circumstances. The likelihood of recovery is contingent upon the reason of the coma, the ability of the condition to be remedied, and the duration of the coma. If the condition is remedied, the individual frequently reverts to their previous level of functioning. However, if the brain injury is serious enough, a person may become permanently incapacitated or lose consciousness.
Comas caused by drug overdose are more likely to recover with immediate medical intervention. Comas caused by head traumas often have a better recovery rate than comas caused by a lack of oxygen.
When a person is in a coma, predicting recovery can be extremely difficult. Each individual is unique, and it is essential to talk with your physician. As expected, the longer a person is unconscious, the worse the prognosis. Despite this, many individuals can awaken after weeks in a coma. They may, however, have serious disabilities and thus need physiotherapy or occupational therapy.
- From Wikipedia, the free encyclopedia; Retrieved from Coma - Wikipedia
- Coma. Retrieved from Coma - NHS (www.nhs.uk)
- Medically Reviewed by Christopher Melinosky, MD on September 14, 2020. Retrieved from Coma: Types, Causes, Treatments, Prognosis (webmd.com)
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